Employment Reference Form

Blue Ridge Assembly conducts a collegiate work-study program. It involves working in customer service departments, living in Assembly dormitories and participating in staff recreation, spiritual and educational programs.

Email *

Applicant Name *

Date *

Month

Day

Year

Full Name

Address

City

State

Zip

Phone *

This person is being considered for employment by our organization and has granted permission for information concerning his/her character to be secured. Your confidential answers to the following questions will help us better evaluate the applicant. Thank you for your assistance.

Charater

Superior

Very Good

Good

Fair

Poor

Not Known

General Attitude

Superior

Very Good

Good

Fair

Poor

Not Known

Ability to Get Along with Others

Superior

Very Good

Good

Fair

Poor

Not Known

Communication with Others

Superior

Very Good

Good

Fair

Poor

Not Known

Dependability

Superior

Very Good

Good

Fair

Poor

Not Known

Honesty

Superior

Very Good

Good

Fair

Poor

Not Known

Independent Initiative

Superior

Very Good

Good

Fair

Poor

Not Known

Observance of Rules & Regulations

Superior

Very Good

Good

Fair

Poor

Not Known

Acceptance of Supervision

Superior

Very Good

Good

Fair

Poor

Not Known

Behavior/Emotional Stability

Superior

Very Good

Good

Fair

Poor

Not Known

Personal Habits

Superior

Very Good

Good

Fair

Poor

Not Known

Safety Habits

Superior

Very Good

Good

Fair

Poor

Not Known

Judgement

Superior

Very Good

Good

Fair

Poor

Not Known

Leadership

Superior

Very Good

Good

Fair

Poor

Not Known

How many years have you known this person? *

What is your relationship to this person?

What do you feel are this person’s major strengths and weaknesses? Be specific.

Do you recommend the acceptance of the applicant as an employee of YMCA Blue Ridge Assembly?